Tennessee's ban on gender-affirming care for transgender youth can go into effect after a federal appeals court on Saturday temporarily reversed a lower court ruling. The ruling is preliminary and remains in force only until the appeals court conducts a full review of the appeal. 

Late last month, a district court judge in Tennessee found that the state's new law banning transgender therapies like hormone blockers and surgeries for transgender youth was unconstitutional because it discriminated on the basis of sex. The judge blocked large swaths of the law from taking effect.

On Saturday, however, the Sixth U.S. Circuit Court of Appeals in Cincinnati granted an emergency appeal from Tennessee. In a 2-1 ruling, the majority wrote that decisions on emerging policy issues like transgender care are generally better left to legislatures rather than judges. The law, which was scheduled to go into effect on July 1, can go into effect immediately. 

"Given the high stakes of these nascent policy deliberations —the long-term health of children facing gender dysphoria— sound government usually benefits from more rather than less debate," wrote Chief Judge Jeffrey Sutton, an appointee of former President George W. Bush.

Tennessee's attorney general, Jonathan Skrmetti, praised the ruling, saying the ban can now be fully enforced. "The case is far from over, but this is a big win," he said in a statement.

Advocates for gender-affirming care, on the other hand, condemned the ruling. 

"This ruling is beyond disappointing and a heartbreaking development for thousands of transgender youth, their doctors, and their families," the ACLU of Tennessee, other advocates and attorneys said in a joint statement. "As we and our clients consider our next steps, we want all the transgender youth of Tennessee to know this fight is far from over and we will continue to challenge this law until it is permanently defeated and Tennessee is made a safer place to raise every family." 

The American Civil Liberties Union said the Sixth Circuit is the first federal circuit to allow a ban on transgender health care for minors to go into effect. 

Judge Sutton wrote that the appeal process will be expedited, with a goal of resolving the case by Sept. 30. Sutton acknowledged that other judges have ruled differently.

"We appreciate their perspectives, and they give us pause," he wrote. "But they do not eliminate our doubts."

The dissenting judge, Helene White,  ruled that she believes the Tennessee law is likely unconstitutional, but said she would not have applied her ruling statewide, as the district court did. She said she would have limited her ruling to apply only to the nine plaintiffs who filed the lawsuit and to the Vanderbilt University Medical Center, where some of the plaintiffs had sought care.

"I fail to see how the state can justify denying access to hormone therapies for the treatment of minor Plaintiffs' gender dysphoria while permitting access to others, especially in light of the district court's robust factual findings on the benefits of these treatments for transgender youth," White wrote.

The federal government has also filed its own challenge to the Tennessee law. Tennessee is one of several states across the country that have recently enacted bans on gender-affirming care for minors. Federal judges in Arkansas, Indiana and Kentucky have also struck down those state's bans.

The law bans Tennessee health care providers from offering hormone treatments or surgeries for transgender youth where the purpose is to allow the child to express a gender identity "inconsistent with the immutable characteristics of the reproductive system that define the minor as male or female."

Tennessee's controlled legislature passed the law after Vanderbilt University Medical Center was accused of opening its transgender health clinic because it was profitable. Videos surfaced of a doctor there touting that gender-affirming procedures are "huge money makers." Another video showed a staffer saying anyone with a religious objection should quit.

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